The patient has sustained an ischemic stroke involving the left cerebral hemisphere. Which of the following neurologic abnormalities would you expect to see? (Select all that apply.)
a. Aphasia
b. Left visual field defect
c. Difficulty balancing his checkbook
d. Ataxic gait
e. Somnolence
A, C
With strokes in the left (dominant) hemisphere, patients may have aphasia; right hemiparesis; right-sided sensory loss; right visual field defect; poor right conjugate gaze; dysarthria; and difficulty in reading, writing, or calculating. With strokes in the right (nondominant) hemisphere, patients may have neglect of the left visual space, left visual field defect, left hemiparesis, left-sided sensory loss, poor left conjugate gaze, extinction of left-sided stimuli, dysarthria, and spatial disorientation. With strokes in the brainstem, cerebellum, and posterior hemisphere, patients may have motor or sensory loss in all four limbs, crossed signs, limb or gait ataxia, dysarthria, disconjugate gaze, nystagmus, amnesia, and bilateral visual field defects.
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